The purpose of this twenty-seven month anthropological study is to investigate family involvement in nursing home decision-making with particular emphasis on everyday decisions that significantly affect the quality of life of elderly residents. The specific aims are: (1) to describe the natural history of family involvement in decision-making in nursing homes; (2) to identify correlates of family involvement in decision-making; (3) to examine the relative contribution of family in relation to other actors in the decision-making process; (4) to identify, describe, and interpret the taken-for-granted norms and rules of behavior influencing family involvement in decision-making in contrasting nursing home environments, and (5) to develop theory regarding the role of family in nursing home decision-making. The project will monitor family involvement at different levels of decision-making (ranging from everyday living decisions to crisis or life and death decisions) in four nursing homes. The project will conduct intensive study of representative elderly residents and those who participate in decisions affecting these residents, including family members, nursing staff, physicians, non-medical staff, administrators and others. Three complementary data collection strategies will be employed -- participant observation, repeated semi-structured in-depth interviews, and event analysis. These data will be supplemented by information from resident records and by formal measures to assess the medical, functional, mental, and social characteristics of residents and family members. Qualitative analysis will include detailed interpretive case studies, systematic identification and description of significant themes in the decision-making process, and identification of grounded variables for inclusion in quantitative analyses. Bivariate analyses will be used to identify resident, family, and contextual correlates of family involvement in nursing home decision-making. Specific hypotheses regarding levels of family involvement at different levels of decision-making will be tested. The qualitative and quantitative findings will be integrated in the development of a theory of family involvement in institutional decision- making. Knowledge gained from this research will contribute to defining appropriate roles and responsibilities for families in nursing homes and may also suggest intervention strategies that will enhance resident and family involvement in decisions affecting residents' quality of life.